Uncommon Surgical Management by AVF between the Great Saphenous Vein and Anterior Tibial Artery for Old Radiocephalic AVF Failure

Abstract

Introduction: Autologous native arteriovenous fistula (AVF) created in the non-dominant arm is the gold standard vascular access for dialysis in end-stage renal disease, but the post-surgical vascular access dysfunction causes a reduction in the patient’s quality of life. Creating a functional upper extremity permanent arteriovenous access is limited by the upper limb’s vascular resources, so good management of a complicated arteriovenous fistula may improve patient outcomes. This article highlights the importance of new surgical options in treating complicated AVFs. Case report: We present the case of a patient with a 17-year-old complex radio-cephalic arterio-venous fistula and a series of surgical interventions performed for life salvage in the first place and functional vascular access in the second place. Furthermore, we describe a successfully created uncommon type of fistula in the lower extremity between the great saphenous vein and the anterior tibial artery as the last possible access for hemodialysis in this patient. Results: The patient underwent the first successful dialysis using the newly created lower limb fistula 1 month after the surgery. Conclusion: Applying new surgical techniques to manage AVFs gives a unique chance to improve the quality of life and reduce morbidity and mortality in these patients.

Intimal CD31-Positive Relative Surfaces Are Associated with Systemic Inflammatory Markers and Maturation of Arteriovenous Fistula in Dialysis Patients

“…The current literature suggests that the arteriovenous fistula (AVF) is the optimal vascular access route for dialysis in patients with end-stage kidney disease (ESKD) [ 2 , 3 ], with patency rates at one year ranging from 52–71% for the radiocephalic AVF (RCAVF) [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ], 75–89% for the brachiocephalic AVF (BCAVF) [ 12 , 13 , 14 , 15 , 16 , 17 , 18 ], and 64–89% for the brachiobasilic AVF [ 12 , 16 , 19 , 20 , 21 , 22 , 23 ]. According to the above-mentioned publications, early failure occurs in between 5 and 37% of patients in the case of RCAVF (4–11), 8–16% in the case of BCAVF [ 12 , 13 , 14 , 15 , 16 , 17 , 18 ], and 2–23% in the case of BBAVF, all within one month after access creation [ 12 , 16 , 19 , 20 , 21 , 22 , 23 ].…”

The Predictive Value of NLR, MLR, and PLR in the Outcome of End-Stage Kidney Disease Patients

“…At the national level, until 31 December 2020, 13,663 patients were registered for RRT, out of which 13,374 were on hemodialysis, and only 289 were on peritoneal dialysis [ 4 ]. The most stable site of dialysis with a long-life expectancy are arteriovenous fistula (AVF) [ 5 ], whereas acute ill patients need central venous hemodialysis catheter (CVC) dialysis.…”

The Predictive Value of Systemic Inflammatory Markers, the Prognostic Nutritional Index, and Measured Vessels’ Diameters in Arteriovenous Fistula Maturation Failure

“…An arteriovenous fistula (AVF) is the first-line vascular access pathway for patients diagnosed with end-stage renal disease (ESRD), with a lower rate of complications and superior patency compared to an arteriovenous graft (AVG) and a central venous dialysis catheter (CVC) [1][2][3][4][5]. For efficient hemodialysis, the vascular access path must be optimal, ensuring a minimum flow of 300 mL/min, being cannulated with two needles, and presenting prolonged patency [6,7].…”